Acne and Lifestyle: How to Lessen Its Effects
Acne vulgaris, also called hormonal acne or adult acne, affects people worldwide. The disease has exhibited a global distribution and has continued to increase in prevalence over time within the worldwide population, and this continued growth represents an unmet dermatologic need. According to research, hormonal acne will affect up to 80% of all people at some point between the ages of eleven and thirty   . However, beyond the age of twenty-five, it occurs in 3% of men and 12% of women .
This type of acne is greatly influenced by hormonal changes, along with other factors, including bacteria, cellular skin abnormalities, stress levels, genetics, and lifestyle. Although this condition is commonly treated with prescription antibiotic medications, a significant amount of research shows the disease could be curtailed with proper lifestyle and diet.
In this article, we will review some of the research investigating the association between diet and lifestyle factors and the progression of hormonal acne.
What is Hormonal Acne?
Hormonal acne is characterized by blackheads, whiteheads, rashes, inflammation, and deep lesions, with the latter being less common but more serious.
Research has classified this condition according to its severity :
- Mild acne: non-inflammatory lesions (comedones), a few inflammatory (papulopustular) lesions, or both
- Moderate acne: more inflammatory lesions, occasional nodules, or both, and mild scarring
- Severe acne: widespread inflammatory lesions, nodules, or both, and scarring, moderate acne that has not settled with six months of treatment, or acne of any "severity" with severe psychological upset
Severe acne can lead to permanent scarring or disfigurement of the skin, which can result in withdrawal from social environments and severe emotional distress that can lead to depression and .
While hormonal acne will typically appear on the face, it can appear on all parts of the body that have sebaceous glands, including the face, back, neck, and upper arms .
The Causes Behind Hormonal Acne
No one factor leads to acne; however, hormonal fluctuations play a significant role; hence, the name: hormonal acne. Additional causes include an individual’s genetic predisposition, inflammation, excess bacteria, and follicular hyperkeratinization.
Follicular hyperkeratinization is considered a key element in the pathogenesis of acne and occurs when hair follicle cells or skin cells become cohesive and do not shed onto the skin’s surface normally . These skin and hair cells clog the pore, making what is called a microcomedone   .
Additionally, Propionibacterium acnes (P. acnes) is a type of bacteria that usually grows on healthy skin. However, when people have acne, it grows abnormally, which can contribute to follicular hyperkeratinization, inflammation, skin damage, and alteration of sebum .
Hormones play an essential role in the proliferation of acne. Therefore, acne typically appears during life periods of hormonal fluctuation, such as puberty, pregnancy, menopause, and when women consume birth control medication .
Also, inflammation plays a role in acne, and although many people argue its role is less influential, there is still a lot of research that supports that dietary changes can make a substantial impact in acne treatment .
Diet and Acne
In this section, we will review scientifically-based research that examines how dietary habits can reduce acne symptoms.
Blood Sugar and Glycemic Index Fluctuations have a predominant influence on acne symptoms. When someone eats something that has a high glycemic index, such as white bread, sugary foods, candy, and cereal, they can experience blood sugar fluctuations, which can increase acne symptoms .
These foods cause the body to release a considerable amount of insulin to transport the glucose [sugar] to cells, and this stimulates the release of other hormones, such as insulin-like growth factor 1 (IGF-1). Consequentially, an increase in these hormones contributes to hyperkeratinization and an overabundance of sebum production, which, again, can worsen acne symptoms .
Because researchers have noted this effect, scientists have conducted studies investigating the results of a low-glycemic diet on acne symptoms and pointed out that a low-glycemic diet could help alleviate symptoms  .
Moreover, when scientists compared specific diets characterized by their food types, researchers noticed the Western diet, which is the traditional American diet high in sugary, high-glycemic foods, leads to more widespread acne, and more conventional diets that do not contain many sugars or processed foods have much lower associated acne symptoms  .
As a result, cutting these foods from one’s diet may help alleviate acne symptoms.
Dairy products are widely known to promote insulin secretion and the production of hormones, including IGF-1, which is a significant contributor to acne proliferation .
In a 2018 meta-analysis that included 78,529 people [ages 7-30], researchers investigated the association between dairy intake and acne symptoms . The researchers found that, regardless of the amount, consuming dairy products increase the prevalence of acne .
In another 2018 meta-analysis that included 71,819 people, researchers concluded that their “meta-analysis provides evidence of a positive correlation between milk consumption and acne risk” .
Whey protein, the main protein in milk, has also demonstrated a positive association with acne in several studies    .
Therefore, cutting dairy products from an individual’s diet may help to relieve acne symptoms.
Unprocessed, nutrient-packed foods can help to decrease acne symptoms, especially combined with anti-inflammatory foods since inflammation is one of the leading causes of acne . For example, choosing omega-3 fat sources, such as salmon and cod, over inflammatory fat sources, such as canola or soybean oils, may help lessen acne breakouts    .
Further, choosing vegetables and whole foods over processed foods can help to decrease inflammation, since these foods deliver anti-inflammatory nutrients and pro-skin compounds, such as vitamin C, that are vital for maintaining overall skin health .
Foods to Consider
Since many foods are acne-causing and pro-inflammatory, such as dairy products, highly processed foods, and sugary foods, there are healthy alternatives. For example, instead of dairy milk, try considering cashew, almond, or coconut milk.
There are protein sources that do not contain dairy, such as fish, lentils, and eggs, healthy versions of fats, such as olive oil, avocados, seeds, and nuts, and naturally sweet snacks, such as fresh strawberries and fruit.
Further, certain anti-inflammatory compounds can be integrated into one’s diet, such as curcumin, turmeric, ginger, pepper, and cayenne.
Supplements to Consider
In this section, we will review specific supplements that may help alleviate acne symptoms.
Vitamin D. A fair amount of research has associated low vitamin D levels to increased prevalence of acne, and this would make sense because vitamin D is a natural anti-inflammatory .
In a 2016 randomized, placebo-controlled trial, researchers investigated the association between an individual’s vitamin D levels and their risk of acne development . There were two groups: one group of people who had acne and control group of people without acne; both groups contained eighty individuals.
The researchers found that 50% of the individuals in the acne group were deficient in vitamin C, whereas only 23% of the patients in the control group had insufficient levels .
After a follow-up, the researchers found that supplementing with 1,000 IU of vitamin D a day for two months substantially improved acne symptoms in individuals who were deficient in this vitamin .
Green Tea. Researchers have also investigated the anti-acne effects of green tea, which is attributed to the tea’s potent antioxidant profile and powerful anti-inflammatory effects .
In a 2016 randomized, double-blind, placebo-controlled trial that involved eighty women [ages 25 to 45], researchers investigated green tea extract’s anti-acne effects . The researchers concluded, “GTW [green tea extract] resulted in significant reductions in lesions located on the nose, perioral area and chin” . The researchers then called for future research to determine whether decaffeinated or standard extract would be more beneficial.
Fish Oil. Because fish oil typically has anti-inflammatory properties, researchers have investigated its effects on acne.
In a 2012 study, researchers gave individuals with inflammatory acne a fish oil supplement for three weeks and told the participants not to change their diets or existing acne remedies . At the end of the twelve weeks, researchers noted 62% of the participants had improved symptoms, 31% had worsened symptoms, and 7% had persistent symptoms, noting it was somewhat useful .
However, because the researchers told the participants not to change their diets, if their diets were contributing to their acne, it may have dampened the effects of the fish oil supplement.
Vitamin B5. Pantothenic acid, also known as vitamin B5, helps the body acquire energy from food and is involved in cholesterol and hormone production .
In a 2014, randomized, double-blind, placebo-controlled trial, researchers investigated the effects of vitamin B5 supplementation on acne symptoms over twelve weeks . The researchers noted a significant mean reduction in total lesion count in the supplement group versus the control group.
The researchers concluded, “The results from this study indicate that the administration of a pantothenic acid-based dietary supplement in healthy adults with facial acne lesions is safe, well tolerated and reduced total facial lesion count versus placebo after 12 weeks of administration” .
Zinc. The mineral zinc is essential for optimal skin health, and deficiency status may cause various skin disorders, including perioral, acral, and perineal dermatitis .
In a 1980 double-blind, placebo-controlled study, researchers investigated the benefits of zinc supplementation in people with acne over twelve weeks . After the study period, 58% of the supplement group showed improvement, whereas patients in the placebo group showed no improvement .
In a 1989 study, researchers also noted the acne-alleviating effects of zinc supplementation .
Probiotics. In a 2017 study, researchers investigated and noted the strong effect of probiotics on skin health: “Beyond eczema, additional research in probiotics and dermatological pathologies has examined conditions such as acne and mastitis, which have evidence to suggest they may be caused by infection with pathogenic bacteria (Propionibacterium acnes in acne and Staphylococcus aureus in mastitis)” .
The study noted the beneficial effects of Lactobacillus salivarius and Lactobacillus gasseri, among other strains, on acne symptoms .
In a 2011 study, researchers noted this effect could be attributed to probiotics’ ability to balance the gut-brain-skin axis .
Additional Contributing Factors
Along with diet and supplementation, there may be further lifestyle actions that contribute to acne symptoms.
Smoking. In a 2009 study, researchers investigated the relationship between smoking and acne and found “clinical evidence and experimental data shows a straight correlation between smoking habit and post-pubertal acne in which the clinically non-inflammatory type-APAA-is [(atypical) post-adolescent acne] the most frequent. In the more severe cases we could consider APAA as a new entity (smoker’s acne)” .
Alcohol, Sleep, and Stress. In a 2011 study, researchers noted alcohol consumption, lack of sleep, and stress aggravate acne .
In this article, we examined the characteristics and causes of one of the most common types of acne: hormonal acne. Further, we investigated certain foods, such as high-glycemic foods and dairy products, that can aggravate acne symptoms, and noted how whole, nutrient-dense foods could help alleviate symptoms. Then, we reviewed various compounds have scientifically in studies to reduce acne symptoms in some patients and reviewed lifestyle actions that can promote acne breakouts.
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